内科理论与实践

内科理论与实践 ›› 2022, Vol. 17 ›› Issue (03): 248-252.doi: 10.16138/j.1673-6087.2022.03.014

• 论著 • 上一篇    下一篇

腹膜透析患者跌倒发生的现况调查

黄晓敏1, 章倩莹1, 杨俪1, 崔岩1, 徐天1, 王子秋1,2, 王朝晖1, 任红1, 张春燕1()   

  1. 1.上海交通大学医学院附属瑞金医院肾脏科,上海 200025
    2.上海交通大学医学院,上海 200025
  • 收稿日期:2021-07-22 出版日期:2022-05-30 发布日期:2022-08-09
  • 通讯作者: 张春燕 E-mail:rivermere@hotmail.com

A cross-sectional study of falls in peritoneal dialysis patients

HUANG Xiaomin1, ZHANG Qianying1, YANG Li1, CUI Yan1, XU Tian1, WANG Ziqiu1,2, WANG Zhaohui1, REN Hong1, ZHANG Chunyan1()   

  1. 1. Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2. Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2021-07-22 Online:2022-05-30 Published:2022-08-09
  • Contact: ZHANG Chunyan E-mail:rivermere@hotmail.com

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摘要：

目的：探讨居家腹膜透析患者跌倒发生的危险因素,为制定居家透析患者安全管理策略提供依据。方法：选择2019年1月—12月期间在我院腹膜透析门诊长期随访符合条件的147例腹膜透析患者,每3个月常规评估时回顾性调查3个月内和1年内跌倒发生情况,并使用Logistic 多元回归分析发生跌倒的危险因素。结果：1年内共有32例患者发生跌倒,共计51例次,跌倒发生率为21.8%。将所有患者根据有无发生跌倒分为未跌倒组与跌倒组,比较糖尿病（7.8%比21.9%, P=0.048）、透析龄[26.0（11.0, 49.3）个月比44.4（24.1, 76.8）个月, P=0.002]、内生肌酐清除率（endogenous creatinine clearance rate, CCR）[58.61（50.85, 79.16） L/周比51.53（45.39, 59.50） L/周, P=0.001]、血浆白蛋白[（36.6±4.1） g/L比（34.9±4.3） g/L, P=0.047]、血磷[1.6（1.4, 1.9） mmol/L比1.7（1.5, 2.2） mmol/L, P=0.05]、24 h尿量[700（60, 1 100） mL/24 h比75（0, 488） mL/24 h, P=0.002]、透析液超滤量[600（300, 900） mL/24 h比800（472, 1 160） mL/24 h, P=0.002]、降压药物种类数量（≤3种80.9%比56.3%,≥4种19.1%比43.8%, P=0.004 2）、移动能力（无需帮忙98.3%比87.5%,搀扶或拐杖0比12.5%,轮椅1.7%比0, P=0.021）均为跌倒发生的危险因素。Logistic 多元回归分析显示合并糖尿病[优势比（odds ratio, OR）=6.569, P=0.007]、透析龄长（OR=1.022, P=0.011）、血磷高（OR=3.372, P=0.024）、使用降压药物种类多（OR=3.601, P=0.015）、24 h尿量减少（OR=1.001, P=0.039）是跌倒发生的危险因素。结论：腹膜透析患者发生跌倒是多种因素综合作用的结果,应及早采取针对措施预防跌倒发生。

关键词: 腹膜透析, 跌倒, 危险因素

Abstract:

Objective To explore the risk factors of falls in the patients receiving peritoneal dialysis and provide the basis for their safety managements. Methods A total of 147 patients receiving peritoneal dialysis who matched the requirements from January to December 2019 in the peritoneal dialysis clinic of our hospital were selected. In one year, the incidence of falls was retrospectively investigated through every three months’ evaluation. The Logistic multiple regression was used to analyze the independent risk factors of falls in these patients. Results A total of 51 falls occurred in 32 cases in one year, and the fall rate was 21.8%. The patients were divided into two groups, which were fall group and non-fall group. Comparing fall group with non-fall group, the risk factors for falls were as follows: diabetes (7.8% vs 21.9%, P=0.048), dialysis age [26.0 (11.0, 49.3) months vs 44.4(24.1, 76.8) months, P=0.002], endogenous creatinine clearance rate (CCR)[58.61(50.85,79.16) L/week vs 51.53 (45.39, 59.50) L/week, P=0.001], albumin [(36.6±4.1) g/L vs (34.9±4.3) g/L, P=0.047], phosphorus [1.6 (1.4, 1.9) mmol/L vs 1.7 (1.5, 2.2) mmol/L, P=0.05], 24-hour urine volume [700(60,1 100) mL/24h vs 75(0, 488) mL/24h, P=0.002], ultrafiltration volume of dialysate[600(300, 900) mL/24h vs 800(472,1 160) mL/24h, P=0.002], number of antihypertensive drugs (≤3: 80.9% vs 56.3%, ≥4: 19.1% vs 43.8%, P=0.004 2), amobility (no help 98.3% vs 87.5%, help or crutch 0 vs 12.5% and wheelchair 1.7% vs 0, P=0.021). The Logistic multiple regression analysis showed that diabetes [odds ratio(OR)=6.569, P=0.007], dialysis age(OR=1.022, P=0.011), blood phosphorus(OR=3.372, P=0.024), the use of antihypertensive drugs(OR=3.601, P=0.015), 24-hour urine volume（OR=1.001, P=0.039） were independent risk factors for falls. Conclusions The falls in the patient receiving peritoneal dialysis is the result of multiple factors, and it’s important to adopt necessary measures to prevent falls in these patients.

Key words: Peritoneal dialysis, Fall, Risk factors

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